RFN on Lumbar Facet Joint

Abstract

The therapeutic armamentarium for painful facet joints includes conservative therapy (analgesics, muscle relaxants, non-steroidal anti-inflammatory drugs, immobilization, bed rest and physical therapy), percutaneous intra-articular infiltrations with a mixture of long-acting corticosteroid and local anaesthetic and facet joint denervation by means of radiofrequency (RF) ablation or cryoablation. The term neuromodulation describes the application of pulsed radiofrequency for 140 s raising temperature at 42 C, whilst the term neurolysis describes the application of continuous radiofrequency for 60 s raising temperature at 60–90 C. Prior to any denervation procedure in the facet joints, a diagnostic infiltration should be performed to verify that the specific facet joint is the actual pain source of the patient. Percutaneous facet joint neurolysis in the lumbar spine using radiofrequency ablation is a safe and cost-effective technique which is performed under imaging guidance and local anaesthesia as outpatient procedure. Extensive and strict sterility is a prerequisite. Radiofrequency neurolysis is a feasible and reproducible, efficient (70–80 % success rate) and safe (>0.5 % mean complications rate) therapy for the treatment of symptomatic facet joint syndrome.